MEDICARE: ROCKY MOUNTAIN MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1295580082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN MEDICAL LLC

Provider Business Mailing Address
First Line	:	535 W SUNNYSIDE RD STE 2
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-4647
Country	:	US
Telephone Number	:	208-357-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 W SUNNYSIDE RD STE 2
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-4647
Country	:	US
Telephone Number	:	208-357-9700
Fax Number	:	208-963-3245

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MATTHEW D WOOD
Credential	:
Telephone Number	:	208-357-9700

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	03/04/2026

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Directions to “ROCKY MOUNTAIN MEDICAL LLC ” Practice Location

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